ARKANSAS COURT OF APPEALS

NOT DESIGNATED FOR PUBLICATION

TERRY CRABTREE, JUDGE

DIVISION II

WILLIAM R. WHITE

APPELLANT

V.

CARCO CARRIAGE

CORPORATION

APPELLEE

CA 00-1175

MAY 9, 2001

APPEAL FROM THE ARKANSAS

WORKERS' COMPENSATION

COMMISSION

[NO. E810049, E9102731]

AFFIRMED

The Workers' Compensation Commission affirmed the decision of the Administrative Law Judge (ALJ), which found that appellant suffered from carpal tunnel syndrome on his left hand. However, the ALJ also concluded that appellant failed to prove that he suffered permanent physical impairment to the second, third, and fourth fingers of his right hand, that he failed to prove that he suffered carpal tunnel syndrome in his right hand, and that he was not entitled to temporary-total disability benefits after January 22, 1999. On appeal, appellant contends that the Commission erred in finding that he suffered no permanent physical impairment to three of his fingers on his right hand, that carpal tunnel syndrome in his right hand was not work related, and that he was not entitled to temporary-total disability benefits after January 22, 1999. On cross-appeal, appellee argues that the Commission erredin concluding that appellant suffered from carpal tunnel syndrome in his left hand. We affirm.

The appellee, Carco Carriage Corporation, employed appellant as a truck driver. Appellant began working for appellee on June 16, 1998. On July 23, 1998, appellant sustained crush injuries to the second, third, and fourth fingers of his right hand when his hand was caught under a heavy object that was being unloaded from his truck. Appellee accepted this injury as compensable. Appellant continued to work until July 29, 1998. Then, appellant took six days of leave that he was owed by appellee. However, appellant remained off work until August 21, 1998, when he returned and drove for appellee until September 2, 1998.

On September 8, 1998, appellant reported to his supervisor that he experienced numbness in his left hand. On that same day, appellant received medical care from Dr. Lewis Mejico at the Veteran's Administration in Washington, D.C. Dr. Jeffery Abend also treated appellant for finger injuries, and then Dr. Abend referred him to an occupational therapist from October 1, 1998, through November 16, 1998. On November 17, 1998, Dr. Abend released appellant to return to work with restrictions prohibiting him from lifting over twenty pounds or driving large vehicles. Appellee could not provide a job within appellant's restrictions and terminated his employment. On November 19, 1998, an EMG study was performed and interpreted as being mildly abnormal. Dr. Sherry DeSilva, a neurologist who conducted the test, opined that the results were consistent with bilateral entrapment of the median nerves, with the right being worse than the left.

First, appellant maintains that the Commission erred in finding that he failed to prove that he suffered permanent physical impairment to the second, third, and fourth fingers of his right hand. Appellant bears the burden to prove physical or anatomical impairment by objective and measurable physical findings. Ark. Code Ann. § 11-9-704(C)(1)(B) (Repl. 1996). "Objective findings" are those findings that cannot come under the voluntary control of the patient. Ark. Code Ann. § 11-9-102(16)(A)(i). The only medical evidence offered by appellant on this issue is the report of Dr. Jeffery Abend dated August 19, 1999, which states:

As far as the residuals on the right side, his x-rays show his fractures have healed. His range of motion limitations and deficits are minimal and not assignable under the AMA Fourth Edition Guidelines. He does have 15-20% grip strength diminution on that right side compared to the left, and for this I would give him a 2% upper extremity impairment. In addition, I would give him another 2% upper extremity impairment on the right because of complaints of pain, fatiguability, weakness, and lack of endurance, summing to a 4% disability rating on the right side upper extremity, cause and effect from his accident of July in 1998.

None of the factors upon which Dr. Abend states that his assessment is based would be considered objective findings as required by the statute. Because appellant did not present any objective physical findings to support Dr. Abend's impairment rating assessment, we uphold the Commission's decision that appellant suffers no permanent physical impairment to his second, third, and fourth fingers.

Second, appellant argues that the Commission erred in finding that he failed to prove that he suffered carpal tunnel syndrome in his right hand. Appellant maintains that he developed carpal tunnel syndrome in his right hand as a result of the physical therapyprovided to him as treatment for his compensable finger injuries. When a worker sustains a compensable injury, then every natural consequence of that injury is also compensable. Hubley v. Best Western Governor's Inn, 52 Ark. App. 226, 916 S.W.2d 143 (1996). The basic issue is whether there is a causal connection between the initial injury and the alleged consequential condition. Jeter v. B.R. McGinty Mechanical, 62 Ark. App. 53, 968 S.W.2d 645 (1998). Consequential injuries need not arise within the time and space boundaries of the employment. Employers may be liable for injuries resulting from medical treatment obtained in response to a work-related injury. See Air Compressor Equip. Co. v. Sword, 69 Ark. App. 162, 11 S.W.3d 1(2000).

We find no mention in the physical-therapy records that appellant was experiencing symptoms or complaints during the physical therapy sessions that would be indicative of the onset of carpal tunnel syndrome in his right hand. The only evidence supporting appellant's contention is in Dr. Wallin's deposition testimony. Therein, Dr. Wallin stated that it was "possible" that appellant's carpal tunnel syndrome could have been caused by anything that placed stress on his right hand or wrist, including physical therapy. We agree with the Commission that Dr. Wallin's opinion is not stated within a reasonable degree of medical certainty as required by Ark. Code Ann. § 11-9-102(16)(B). To find a causal connection between appellant's right carpal tunnel syndrome and his compensable finger injuries would require speculation and conjecture. Even if plausible, speculation and conjecture cannot take the place of proof. Arkansas Dep't of Correction v. Glover, 35 Ark. App. 32, 812 S.W.2d692 (1991). Thus, the Commission did not err in finding that appellant did not sustain carpal tunnel syndrome in his right hand as a result of the physical-therapy treatments.

Finally, appellant asserts that the Commission erred in finding that he was not entitled to temporary-total disability benefits after January 22, 1999. Upon finding that appellant's left carpal tunnel syndrome was compensable, the Commission concluded that temporary-total disability benefits should have continued from November 6, 1998, through January 22, 1999. Temporary-total disability is that period within the healing period in which a claimant suffers a total incapacity to earn wages. Stafford v. Arkmo Lumber Co., 54 Ark. App. 286, 925 S.W.2d 170 (1996). In addition, the healing period is that period for healing of an injury which continues until the claimant is as far restored as the permanent character of the injury will permit. Georgia-Pacific Corp. v. Carter, 62 Ark. App. 162, 969 S.W.2d 677 (1998).

Dr. Abend served as appellant's treating physician for his compensable finger injuries. On November 17, 1998, Dr. Abend released appellant to return to work with restrictions against driving and heavy lifting. Dr. Abend instructed appellant to return in one month for a final follow-up visit. Medical records do not reveal that appellant returned for this follow-up. The next medical report of Dr. Abend is dated August 19, 1999, which states that appellant had fully recovered from the fracture to his fingers.

Dr. Mejico provided the primary treatment for appellant's left carpal tunnel syndrome. In his office notation of December 8, 1998, Dr. Mejico noted that appellant was being treated conservatively with physical therapy and splints and should reach maximum medical improvement in the next six weeks. There is no record that appellant continued to seektreatment from Dr. Mejico after this visit. We agree with the Commission that appellant failed to prove that he continued within his healing period from the effects of his compensable left carpal tunnel syndrome after the six weeks had lapsed. The medical records failed to show that appellant received or sought further medical treatment for his condition for a substantial period of time after the anticipated date of maximum medical improvement set by Dr. Mejico in his report of December 8, 1998. The Commission relied on Dr. Mejico's December 8^th report in determining when appellant's healing period ended. This serves as substantial evidence to support the Commission's finding that appellant's healing period ended on January 22, 1998.

On cross-appeal, appellee maintains that the Commission erred in concluding that appellant suffered from carpal tunnel syndrome in his left hand. The Commission believed that appellant sustained carpal tunnel syndrome in his left hand as a result of overusing his left hand at work while protecting his injured right hand. In reaching its determination, the Commission relied on Dr. Mitchell Wallin's medical opinion. Dr. Wallin stated, "It is reasonable to assume the carpal tunnel was initiated by over stressing the left hand while driving during the months after [appellant's] July 1998 crush injury to the right hand." During a deposition, Dr. Wallin was asked how long it took to develop carpal tunnel syndrome. He responded, "it can develop over several months, depending on how many times you're - and where the stresses are. But, usually its weeks." We recognize that appellant only drove for appellee for less than two weeks while his right fingers were injured. Dr. Wallin opined that appellant developed carpal tunnel in his left hand during this rathershort interval. In addition to Dr. Wallin's opinion, Dr. Abend and Dr. Mejico offered opinions stating that appellant's left carpal tunnel syndrome was attributable to overuse.

While driving without the use of his right hand, appellant placed extraordinary stress on his left hand. After reviewing the medical opinions, we believe that the increased use of appellant's left hand caused a rapid onset of carpal tunnel syndrome. Therefore, we find substantial evidence to support the Commission's finding of carpal tunnel syndrome in appellant's left hand.

Affirmed in all respects.

Robbins and Vaught, JJ., agree.